Trial of Glutamine and Antioxidant Supplementation in Critically Ill Patients

NCT ID: NCT00133978

Last Updated: 2021-01-07

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1223 participants

Study Classification

INTERVENTIONAL

Study Start Date

2005-04-30

Study Completion Date

2012-05-31

Brief Summary

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The purpose of this study is to determine whether providing high dose glutamine and antioxidants to critically ill patients will be associated with improved survival.

Detailed Description

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Background:

Critically ill patients experience a degree of hyperinflammation, cellular immune dysfunction, and oxidative stress. Supplementation with key nutrients, like glutamine and antioxidants, is most likely to have a favourable effect on these physiological parameters leading to an improvement in clinical outcomes. The results of two separate meta-analyses suggested that glutamine and antioxidants may be associated with improved survival. We have recently completed a dosing study to determine the maximal tolerable dose (MTD) of glutamine dipeptides and antioxidants in critically ill patients with evidence of hypoperfusion. The purpose of this protocol is to evaluate the effect of high dose glutamine and antioxidant supplementation on mortality in a large scale randomized trial.

Study Intervention:

Patients will be randomized to receive glutamine supplementation or antioxidant supplementation (or respective placebo).

Conditions

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Critical Illness Sepsis Multiple Organ Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Glutamine

Glutamine supplementation

Group Type EXPERIMENTAL

Glutamine

Intervention Type OTHER

0.35 gm/kg/day parenterally and 30 gms/day enterally

Antioxidants

Antioxidant supplementation

Group Type EXPERIMENTAL

Antioxidants

Intervention Type OTHER

500 micrograms of selenium/day parenterally and selenium 300 microgram, zinc 20 mg, beta carotene 10 mg, vitamine E 500 mg and vitamin C 1500 mg per day enterally

Glutamine + Antioxidants

Glutamine and antioxidant supplementation

Group Type EXPERIMENTAL

Glutamine + Antioxidants

Intervention Type OTHER

0.35 g/kg/day glutamine parenterally and 30 g/day of glutamine enterally. 500 mcg selenium parenterally plus the following administered enterally: selenium 300 mcg, zing 20 mg, beta-carotene 10 mg, vitamin E 500 mg and vitamin C 1500mg

Placebo

Non-isonitrogenic, iso-caloric placebo solution

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type OTHER

Normal saline intravenously and EN placebo formula (from Fresenius Kabi, Germany)

Interventions

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Glutamine

0.35 gm/kg/day parenterally and 30 gms/day enterally

Intervention Type OTHER

Antioxidants

500 micrograms of selenium/day parenterally and selenium 300 microgram, zinc 20 mg, beta carotene 10 mg, vitamine E 500 mg and vitamin C 1500 mg per day enterally

Intervention Type OTHER

Glutamine + Antioxidants

0.35 g/kg/day glutamine parenterally and 30 g/day of glutamine enterally. 500 mcg selenium parenterally plus the following administered enterally: selenium 300 mcg, zing 20 mg, beta-carotene 10 mg, vitamin E 500 mg and vitamin C 1500mg

Intervention Type OTHER

Placebo

Normal saline intravenously and EN placebo formula (from Fresenius Kabi, Germany)

Intervention Type OTHER

Other Intervention Names

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Dipeptiven, Microselenium/Selenium injection/selenase, EN REDOX formula (from Fresenius Kabi, Germany)

Eligibility Criteria

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Inclusion Criteria

* Mechanically ventilated patients \> or = 18 years old
* 2 or more organ failures related to acute illness

Exclusion Criteria

* \> 24 hours from admission to ICU
* Patients who are moribund
* Lack of commitment to aggressive care
* Absolute contraindication to enteral nutrients
* Severe acquired brain injury
* Routine elective cardiac surgery
* Primary admission of burns \> 30% body surface area
* Weight \< 50 kgms or \> 200 kgms
* Pregnant or lactating patients
* Previous randomization in this study
* Enrollment in a related ICU interventional study
* Child's class C liver disease
* Metastatic cancer with life expectancy \< 6 months
* Seizure disorder requiring anticonvulsant medication
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fresenius Kabi

INDUSTRY

Sponsor Role collaborator

Daren K. Heyland

OTHER

Sponsor Role lead

Responsible Party

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Daren K. Heyland

Director

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Daren Heyland, MD

Role: STUDY_CHAIR

Clinical Evaluation Research Unit, Kingston General Hospital

Locations

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Univ. of Colorado at Denver and Health Sciences Center

Aurora, Colorado, United States

Site Status

University of Louisville

Louisville, Kentucky, United States

Site Status

Miami Valley Hospital

Dayton, Ohio, United States

Site Status

University of Texas

Houston, Texas, United States

Site Status

Fletcher Allan Centre

Burlington, Vermont, United States

Site Status

UZ Brussels

Brussels, , Belgium

Site Status

University Hospital

Liège, , Belgium

Site Status

Royal Alexandra Hospital

Edmonton, Alberta, Canada

Site Status

Grey Nun's Hospital, Edmonton

Edmonton, Alberta, Canada

Site Status

Vancouver Hospital

Vancouver, British Columbia, Canada

Site Status

St Paul's Hospital

Vancouver, British Columbia, Canada

Site Status

Royal Jubilee Hospital

Victoria, British Columbia, Canada

Site Status

Victoria General Hospital

Victoria, British Columbia, Canada

Site Status

St. Boniface General Hospital

Winnipeg, Manitoba, Canada

Site Status

Health Science Centre

Winnipeg, Manitoba, Canada

Site Status

Capital Health Queen Elizabeth II HSC

Halifax, Nova Scotia, Canada

Site Status

St Joseph's Healthcare

Hamilton, Ontario, Canada

Site Status

Kingston General Hospital

Kingston, Ontario, Canada

Site Status

London HSC Victoria Campus, ON

London, Ontario, Canada

Site Status

Ottawa Hospital

Ottawa, Ontario, Canada

Site Status

Ottawa Hospital Civic Hospital

Ottawa, Ontario, Canada

Site Status

Sunnybrook & Women's College, Toronto

Toronto, Ontario, Canada

Site Status

Mt Sinai Hospital

Toronto, Ontario, Canada

Site Status

Hopital Maisonneuve-Rosemount

Montreal, Quebec, Canada

Site Status

Royal Victoria Hospital

Montreal, Quebec, Canada

Site Status

Montreal General

Montreal, Quebec, Canada

Site Status

Hopital de Sacre-Coeur

Montreal, Quebec, Canada

Site Status

Enfant-Jesus

Québec, , Canada

Site Status

Universitatsklinikum der Ernst-Moritz-Arndt-Universitat

Greifswald, , Germany

Site Status

Asklepios Kliniken Hamburg Altona

Hamburg, , Germany

Site Status

University Medical Center Schleswig-Holstein

Kiel, , Germany

Site Status

Universitatsklinikum Schleswig-Holstein Campus Luebeck

Lübeck, , Germany

Site Status

CHUV

Lausanne, , Switzerland

Site Status

University of Zurich

Zurich, , Switzerland

Site Status

Countries

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United States Belgium Canada Germany Switzerland

References

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Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P; Canadian Critical Care Clinical Practice Guidelines Committee. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr. 2003 Sep-Oct;27(5):355-73. doi: 10.1177/0148607103027005355.

Reference Type BACKGROUND
PMID: 12971736 (View on PubMed)

Heyland DK, Dhaliwal R, Suchner U, Berger MM. Antioxidant nutrients: a systematic review of trace elements and vitamins in the critically ill patient. Intensive Care Med. 2005 Mar;31(3):327-37. doi: 10.1007/s00134-004-2522-z. Epub 2004 Dec 17.

Reference Type BACKGROUND
PMID: 15605227 (View on PubMed)

Novak F, Heyland DK, Avenell A, Drover JW, Su X. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med. 2002 Sep;30(9):2022-9. doi: 10.1097/00003246-200209000-00011.

Reference Type BACKGROUND
PMID: 12352035 (View on PubMed)

Heyland D, Muscedere J, Wischmeyer PE, Cook D, Jones G, Albert M, Elke G, Berger MM, Day AG; Canadian Critical Care Trials Group. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med. 2013 Apr 18;368(16):1489-97. doi: 10.1056/NEJMoa1212722.

Reference Type RESULT
PMID: 23594003 (View on PubMed)

Heyland DK, Elke G, Cook D, Berger MM, Wischmeyer PE, Albert M, Muscedere J, Jones G, Day AG; Canadian Critical Care Trials Group. Glutamine and antioxidants in the critically ill patient: a post hoc analysis of a large-scale randomized trial. JPEN J Parenter Enteral Nutr. 2015 May;39(4):401-9. doi: 10.1177/0148607114529994. Epub 2014 May 5.

Reference Type DERIVED
PMID: 24803474 (View on PubMed)

Related Links

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http://www.criticalcarenutrition.com/index.php?option=com_content&task=view&id=19&Itemid=42

Click here for more information about this study: A Randomized Trial of Glutamine and Antioxidant Supplementation in Critically Ill Patients

Other Identifiers

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EudraCT-No: 2007-001831-73

Identifier Type: -

Identifier Source: secondary_id

REDOXS

Identifier Type: -

Identifier Source: org_study_id

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